As the opioid epidemic’s death toll continues to escalate, politicians and policymakers on both the state and federal levels are scrambling to find the best ways to address this national tragedy.
The latest ideas to gain ground are medically based solutions: deploying marijuana as a painkilling substitute for opioids, and greatly expanding the availability of the overdose reversal drug naloxone.
At first glance, these seem to be easy ways to reduce the U.S. overdose death rate that last year totaled nearly 64,000.
But adding them to our anti-drug toolkit, let’s make sure they are safe and effective and also part of a comprehensive strategy.
Naloxone is already widely used by emergency responders and healthcare professionals as an overdose antidote. Administered as a nasal spray or injection, it can be very effective in reviving an addict who is overdosing and having trouble breathing.
Training more Americans to use it – and ensuring the drug is stocked in schools, clinics and home medicine cabinets – is a good idea, especially for friends and families of substance abusers.
But, if the drug becomes more widely available and affordable (the price has spiked) and if people without a medical background can learn how to properly dose and administer it (addicts sometimes need multiple hits), will there be an end to the opioid crisis? Not in the least.
Saving an addict from one overdose with naloxone doesn’t ensure that he or she will survive the next overdose. More significantly, naloxone won’t change an addict’s life. It can however be the first step on the long road to recovery. It’s what happens after an addict is revived that is crucial to achieving sustained sobriety.
What are most likely to achieve this end are immediate – and legally mandated – evaluation and assessment, and an array of treatment options, from outpatient care to long-term therapeutic community programs for the most vulnerable drug addicts.
Marijuana, for its part, has long been touted as an effective pain reliever, and there is evidence supporting the value of therapeutic cannabinoids. Now, some believe that pot should be enlisted in the fight against opioid addiction as part of a broader strategy.
According to new research looking at Medicare and Medicaid patients in legal marijuana states, easier access to the drug may have been responsible for a reduction in opioid prescriptions of between 6 percent and 8 percent, compared to states where it marijuana is still illegal.
If more people could use cannabis products to relieve pain, the thinking goes, they may be less likely to use opioids, and this in turn could reduce overdose deaths.
Perhaps. These just-published studies identify links between marijuana, pain management and opioid use - but do not reach a definitive conclusion that pot, on its own, led to fewer opioid prescriptions. What’s more, the studies were limited to senior citizens and low-income Americans, and in two legal marijuana states, Connecticut and Maryland, opioid prescriptions did not decline.
All too often in a crisis like the opioid epidemic we seek quick solutions – in this case, drugs like marijuana and an overdose antidote - to help manage the suffering.
But without more studies, and rigorous analysis of current practices, we run the risk of failing the millions of Americans struggling with substance abuse. For them, expanding treatment opportunities is the best investment we can make.
Mitchell S. Rosenthal is a psychiatrist who founded Phoenix House, the national substance abuse treatment organization, and is now president of The Rosenthal Center for the Study of Addiction.
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